Mathieu F Bakhoum1, K Bailey Freund2, Rosa Dolz-Marco3, Belinda C S Leong2, Caroline R Baumal4, Jay S Duker4, David Sarraf5. 1. Department of Ophthalmology, Shiley Eye Institute and Jacobs Retina Center, University of California San Diego, La Jolla, California, USA. 2. Vitreous Retina Macula Consultants of New York, New York, New York, USA. 3. Unit of Macula, Oftalvist Clinic, Valencia, Spain. 4. Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts, USA. 5. Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA. Electronic address: dsarraf@ucla.edu.
Abstract
PURPOSE: To analyze the spectrum of ischemia associated with paracentral acute middle maculopathy (PAMM) in eyes with acute retinal vascular occlusion and to describe an ischemic cascade. DESIGN: A retrospective observational case series. METHODS: Patients presenting with PAMM secondary to acute retinal vascular occlusion were identified. Analysis of multimodal imaging was performed at baseline and at follow-up visits to elucidate the patterns and progression of ischemia within the retinal layers. RESULTS: Multimodal retinal imaging from 16 eyes of 16 patients with acute retinal vascular occlusion associated with PAMM was studied. Analysis of en face optical coherence tomography (OCT) segmentation of the inner nuclear layer (INL) identified distinct patterns of PAMM correlating with the severity of ischemia and not the type of occlusion. A perivenular fern-like PAMM pattern was associated with better visual outcomes (average final visual acuity was 20/25). This pattern was noted to sequentially progress in 2 cases to a diffuse globular PAMM pattern in the INL, or to a pattern of ischemia involving both the middle and inner retinal layers with commensurate vision loss. Globular patterns of PAMM or ischemia involving both the middle and inner retina correlated with poorer visual outcomes (average final visual acuity was counting fingers at 5.5 ft). These various patterns of ischemia developed in eyes with retinal vascular occlusions in which blood flow through the retinal capillary plexuses was present but was significantly reduced and delayed. CONCLUSIONS: This study describes OCT findings suggestive of an ischemic cascade in eyes with retinal vascular occlusion. The middle retina at the level of the deep capillary plexus, especially at the venular pole, may be more vulnerable to ischemic injury. Published by Elsevier Inc.
PURPOSE: To analyze the spectrum of ischemia associated with paracentral acute middle maculopathy (PAMM) in eyes with acute retinal vascular occlusion and to describe an ischemic cascade. DESIGN: A retrospective observational case series. METHODS:Patients presenting with PAMM secondary to acute retinal vascular occlusion were identified. Analysis of multimodal imaging was performed at baseline and at follow-up visits to elucidate the patterns and progression of ischemia within the retinal layers. RESULTS: Multimodal retinal imaging from 16 eyes of 16 patients with acute retinal vascular occlusion associated with PAMM was studied. Analysis of en face optical coherence tomography (OCT) segmentation of the inner nuclear layer (INL) identified distinct patterns of PAMM correlating with the severity of ischemia and not the type of occlusion. A perivenular fern-like PAMM pattern was associated with better visual outcomes (average final visual acuity was 20/25). This pattern was noted to sequentially progress in 2 cases to a diffuse globular PAMM pattern in the INL, or to a pattern of ischemia involving both the middle and inner retinal layers with commensurate vision loss. Globular patterns of PAMM or ischemia involving both the middle and inner retina correlated with poorer visual outcomes (average final visual acuity was counting fingers at 5.5 ft). These various patterns of ischemia developed in eyes with retinal vascular occlusions in which blood flow through the retinal capillary plexuses was present but was significantly reduced and delayed. CONCLUSIONS: This study describes OCT findings suggestive of an ischemic cascade in eyes with retinal vascular occlusion. The middle retina at the level of the deep capillary plexus, especially at the venular pole, may be more vulnerable to ischemic injury. Published by Elsevier Inc.
Authors: Samantha Madala; Fatemeh Adabifirouzjaei; Leonardo Lando; Adeleh Yarmohammadi; Christopher P Long; Christine Y Bakhoum; Michael H Goldbaum; David Sarraf; Anthony N DeMaria; Mathieu F Bakhoum Journal: Ophthalmol Retina Date: 2022-05-16
Authors: Christopher P Long; Alison X Chan; Christine Y Bakhoum; Christopher B Toomey; Samantha Madala; Anupam K Garg; William R Freeman; Michael H Goldbaum; Anthony N DeMaria; Mathieu F Bakhoum Journal: EClinicalMedicine Date: 2021-03-02
Authors: Prashanth G Iyer; Swarup S Swaminathan; Omer Trivizki; Yingying Shi; Mengxi Shen; Mary Kansora; Giovanni Gregori; Philip J Rosenfeld Journal: Am J Ophthalmol Case Rep Date: 2021-03-10